Clinical and radiological results of surgically treated patients with adolescent idiopathic scoliosis and the effects of pulmonary rehabilitation on respiration functions.

BACKGROUND: In the present study, we aimed to evaluate the effects of pulmonary rehabilitation on respiratory functions after the surgery on the basis of early radiological findings, pain degree, function, and satisfaction scores in operated patients with adolescent idiopathic scoliosis (AIS). METHODS: Thirty patients with AIS were included in the present study, who were divided into 2 groups. Scoliosis surgery and diaphragmatic breathing and pursed lip exercises were applied in Group 1 (n = 15), whereas merely scoliosis surgery was applied in Group 2 (n = 15). Pulmonary functions, arterial blood gas analysis, Cobb and kyphosis angles, apical vertebral rotation, and apical vertebral translation were measured before and 1st and 6th months after the surgery. Using the SRS-30 test, the psychosocial statuses of the patients and their satisfaction degrees with surgery applied were measured before and after the surgery. RESULTS: Six months after the surgery, the values of Cobb and kyphosis angles and apical vertebral rotations, and apical vertebral translation of the patients were determined to be significantly ameliorated, which is consistent with the literature. Forced vital capacity (l) and forced expiratory volume in the first second (l/s) were observed to be significantly improved in both groups after the surgery (respectively, P = .001, P = .014, P = .001, P = .005). In addition, the partial pressure of oxygen (pO2) value was found to be significantly increased 6 months after the surgery compared with that before the surgery in Group 2 (P = .022). SRS-30 showed that most of the scores in Group 1 were dramatically increased; a significant difference between the groups was not recorded. CONCLUSION: Patients with AIS have been found to be satisfied with the surgery. Conversely, pulmonary rehabilitation has been shown to slightly improve the respiratory functions in the patients with AIS, 1 and 6 months after the surgery.

Comparison of acetabulum posterior wall fractures and fracture dislocations: dislocation does not affect clinical and radiological outcomes.

The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. 26 patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification.Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p ˃ 0,05). Reduction quality and Matta radiologic scores were correlated significantly in 2 groups. Posterior dislocation may not negatively affect clinical and radiologic outcomes.

Comparison Of Acetabulum Posterior Wall Fractures And Fracture Dislocations: Dislocation Does Not Affect Clinical And Radiological Outcomes.

The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. Twenty-six patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification. Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p > 0,05). Reduction quality and Matta radiologic scores were correlated significantly in 2 groups. Posterior dislocation may not negatively affect clinical and radiologic outcomes.

Surgical excision of peripheral nerve schwannomas: analysis of 11 patients.

OBJECTIVE: Benign schwannomas are the most common tumour of the peripheral nerves. Symptomatic schwannomas are treated by surgical excision, but new neurological deficits may develop. We performed a retrospective review of cases of schwannomas in the extremities and reviewed the relevant literature. METHODS: We retrospectively reviewed the demographic characteristics of 11 patients with schwannomas treated at our institution. We also reviewed the clinical characteristics and postoperative results of these cases, determined the possible risk factors influencing the development of complications and compared the risk factors with those reported in the literature. RESULTS: There were five males and six females with a mean age of 37.6 (range: 17-62) years. The mean postoperative follow-up was 54.6 (range: 26-88) months. Three tumours were located in the forearm and the rest were localized in the lower extremity. No recurrences were observed during the follow-up period. New motor and sensory deficits were observed in only one patient. CONCLUSION: Schwannomas in the extremities can be excised with acceptable risk of neurological deficits. Meticulous dissection is required during surgery.

Comparison of simultaneous bilateral with unilateral total knee arthroplasty.

OBJECTIVE: The aim of this study was to compare simultaneous bilateral total knee arthroplasty (BTKA) and unilateral total knee arthroplasty (UTKA) in terms of morbidity, clinical and radiological findings and quality of life. METHODS: The study included 48 simultaneous BTKAs (46 females, 2 males; mean age: 64.00 ± 8.31 years) and 53 UTKAs (46 females, 7 males; mean age: 64.40 ± 7.45 years) performed between November 2007 and June 2012. Groups were compared with respect to comorbidity, complications, blood transfusion, hospital stay, clinical and radiological (American Knee Society Score) findings and quality of life (SF-36). RESULTS: Three patients in the BTKA group and 1 in the UTKA group required intensive care admission due to pulmonary embolism; 2 cases occurred within the first postoperative 30 days. One BTKA patient died in the early postoperative period and 1 patient from the BTKA and 1 from the UTKA group died within 1 year. Hospital stay, perioperative blood transfusion parameters and mortality rates were significantly different in favor of UTKA and revision operation rates in favor of BTKA (p<0.05). All patients had improved knee and function scores and SF-36 scores. However, there was no significant difference between the groups (p>0.05). CONCLUSION: Simultaneous BTKA should be considered in selected patients under 70 years of age with good compliance and no comorbid disease.

The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life.

OBJECTIVES: Sleep adequacy is one of the major determinants of a successful professional life. The aim of this study is to determine the sleep quality of emergency health workers and analyze its effects on their professional and social lives. METHODS: The study was carried out on 121 voluntary emergency health workers in 112 Emergency Aid Stations in Kayseri, Turkey, in 2011. The data was collected through the Socio-Demographics Form and the Pittsburgh Sleep Quality Index (PSQI) and analyzed via SPSS 18.00. The statistical analysis involved percentage and frequency distributions, mean±standard deviations, a chi-square test, correlations, and logistic regression analysis. RESULTS: The mean score of the participants according to the Pittsburgh Sleep Quality Index was 4.14±3.09, and 28.9% of participants had poor sleep quality. Being single and being a woman accounted for 11% (p=0.009, 95% CI: 0.111-0.726) and 7% (p=0.003, 95% CI: 0.065-0.564) of poor sleep quality respectively. There was a positive correlation between sleep quality scores and negative effects on professional and social life activities. Negative effects on professional activities included increased loss of attention and concentration (40.0%, p=0,016), increased failure to take emergency actions (57.9%, p=0.001), reduced motivation (46.2%, p=0.004), reduced performance (41.4%, p=0.024), and low work efficiency (48.1%, p=0.008). Poor sleep quality generally negatively affected the daily life of the workers (51.6%, p=0.004), restricted their social life activities (45.7%, p=0.034), and caused them to experience communication difficulties (34.7%, p=0.229). CONCLUSIONS: One third of the emergency health workers had poor sleep quality and experienced high levels of sleep deficiency. Being a woman and being single were the most important factors in low sleep quality. Poor sleep quality continuously affected daily life and professional life negatively by leading to a serious level of fatigue, loss of attention-concentration, and low levels of motivation, performance and efficiency.

Fondaparinux versus nadroparin for prevention of venous thromboembolism after elective hip and knee arthroplasty.

OBJECTIVE: To evaluate the efficacy and safety of fondaparinux compared with nadroparin for prevention of venous thromboembolism after arthroplasty. PATIENTS AND METHODS: One hundred fifteen patients were randomized into 2 treatment groups. Patients were given fondaparinux in Group I and nadroparin in Group II. Measurements were performed on Days 1, 5, and 21. The wound area was assessed with a subjective visual analog scale. RESULTS: The blood counts, clinical biochemical tests, and coagulation tests (ie, thrombin time, partial thromboplastin time, activated partial thromboplastin time, fibrinogen, prothrombin time-International Normalized Ratio, and antithrombin III activity) did not show statistically significant differences between Group I and Group II. In both study groups, anti-factor Xa activities increased significantly on the fifth and 21st day. The scores of the subjective visual analog scale showed significance on Day 21. CONCLUSIONS: Our results confirm the safety and efficacy of both fondaparinux and nadroparin for prophylaxis after major orthopedic surgery.

Effect of intraarticular propolis in an experimental septic arthritis model.

To evaluate the efficacy and safety of intraarticular propolis compared with systemic antibiotic treatment in an experimental septic arthritis model. Thirty-two rabbits were infected intraarticularly by Staphylococcus aureus. The rabbits were randomly divided into four groups, including a control group and three experimental groups. Drainage was the only procedure performed in group I (control group). The animals were treated with daily intramuscular cefazolin sodium (75 mg/kg) for 7 days in group II. In group III, intraarticular ethanolic extract of propolis (0.5 mg/ml) was injected to the infected knees under sterile conditions on days 7, 14, and 21 after drainage. In group IV, the rabbits received both intramuscular cefazolin sodium as in group II and intraarticular ethanolic extract of propolis as in group III. After 8 weeks, the animals were killed and joint histopathological and scanning electron microscopic parameters were assessed. The best clinical score was obtained in group IV. There were statistically significant differences among all the groups (P<0.05). The highest total score of the histological examination was found in group I and the best total score was obtained in group IV. There were statistically significant differences among the groups when we evaluated the scores of the parameters as loss of chondrocytes, loss of matrix, and pannus in-growth (P<0.05). But there was no significant difference among the groups for the scores of cloning of the chondrocytes (P>0.05). The highest scanning electron microscopy score was found in group I and the best score was obtained in group IV. Our results confirm the safety and efficacy of intraarticular propolis and synergistic effect of propolis when used with cefazolin in an experimental septic arthritis model.

The healing of full-thickness articular cartilage defects in rabbits: successful results with fibroblast growth factor.

OBJECTIVES: This experimental study aims to compare the effects of three techniques; free autogenous periosteal graft, demineralized bone matrix (DBM) and basic fibroblast growth factor (bFGF) combined with periosteal graft on the healing of full thickness joint cartilage defects in rabbits. MATERIALS AND METHODS: This study used 87 adolescent 16 week-old New Zealand rabbits of both sexes, with an approximate weight of 2500-3750 g. The rabbits were randomly divided into four groups including a control group and three experimental groups. Cartilage defects were created in the posterior weight-bearing area of the medial femoral condyles of the rabbits. The surfaces of the osteochondral defects were covered with free autogenous periosteal graft, DBM and periosteal graft combined with bFGF in the experimental groups respectively. The rabbits were sacrificed at 4, 8 and 12 weeks postoperatively. Macroscopic and microscopic evaluations were performed. RESULTS: Periosteal grafts and DBM respond to the repair of cartilage defects in varying degrees. Although the macroscopic evaluation scores were higher in the bFGF group, there was no statistically significant difference between groups (p>0.05). The total scores on the histological grading scale were significantly higher in the bFGF group and control group than the other groups at 4(th) and 8(th) weeks (p<0.05). At the 12(th) week the total score was significantly higher in the bFGF group than the other three groups (p<0.05). CONCLUSION: The application of bFGF promoted regeneration of articular cartilage and led to successful cartilaginous resurfacing of defects within 12 weeks. We suggest that bFGF when combined with periosteal grafts may have excellent repair capacity in the restoration of osteochondral defects.

Important determinants of quality of life in a peritoneal dialysis population in Turkey.

BACKGROUND: Patients' health-related quality of life (HRQoL) is an important indicator for predicting the effectiveness of treatment, morbidity, and mortality. The aim of this study was to determine the level of HRQoL and the most important factors affecting HRQoL in patients receiving peritoneal dialysis (PD). METHODS: This cross-sectional study was performed with 156 patients, 30 of whom (19.2%) had automated PD (APD), were over 18 years of age, and were followed up at the Erciyes University Continuous Ambulatory Peritoneal Dialysis (CAPD) Unit during the previous year. HRQoL, depression, and fatigue were measured by means of the Short Form-36 (SF-36), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS), respectively. RESULTS: The mean mental component summary (MCS) score was 42.1 ± 11.9 and physical component summary (PCS) score was 39.1 ± 11.2, which was lower than MCS. Depression was the strongest predictor for both diminished mental (ß = -24.4, p < 0.001) and physical (ß = -16.5, p < 0.001) HRQoL. Fatigue was the next strongest predictor for diminished physical HRQoL only (ß = -7.74, p < 0.001). Depression and fatigue accounted for 37% of physical HRQoL impairment. Depression as a sole factor was responsible for 31% of mental HRQoL impairment. Age, hospitalization, total cholesterol, serum albumin levels, and Kt/V urea had affected the SF-36 in some domains score but not in all. CONCLUSION: HRQoL in our PD patients can be evaluated at a slightly poor level compared to the results of previous studies. Impaired HRQoL is more closely associated with depression and fatigue. Depression was the strongest predictor of both mental and physical HRQoL. Fatigue was the next strongest predictor for physical HRQoL only.

[Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study]. / Majör ortopedik cerrahilerde venöz tromboemboli profilaksisi: Cokmerkezli, prospektif, gözlem çalismasi.

OBJECTIVES: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). METHODS: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. RESULTS: Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. CONCLUSION: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.